Recent publicity about professional and college athlete use of performance enhancing supplements and drugs (PEDs) brings good and bad news to parents and coaches of school-age and high school athletes.

The good news is that some parents and coaches are more aware of the health risks of such drugs as steroids, creatine and ephedra. The bad news is that these supplements may be unduly glorified in the eyes of young athletes seeking to perform at higher levels or improve their physique. Worse, parents and coaches may underestimate the news, thinking that performance-enhancing drugs are only a problem of Olympic caliber athletes. Nothing could be farther from the truth.

Surveys Give Parents Pause
A host of surveys confirm that the use of potentially dangerous supplements and PEDs is on the rise in student athletes in all sports, ranging from cross-country and football to gymnastics and lacrosse. In 2003, a Blue Cross Blue Shield Association survey found that 1.1 million young people ages 12 to 17 had used PEDs.

Key survey results showed that:
· Use of sports supplements and performance-enhancing product use is common among middle and high school athletes
· PED use increases substantially once youth are 15 to 17 years old
· Creatine is the most highly used supplement, according to all youth surveyed between the ages of 10 to 17, followed by steroids
· Ephedra-related product use appears to be rising
· Improved performance, appearance and muscle strength are among the top reasons youth athletes use PEDs
· Most buy supplements directly over-the-counter at supermarkets, nutrition stores or through the Internet
· Most learn about supplements from friends

The study found that while parents are aware and concerned about youth athletes using PEDs, many felt they didn’t know enough about the health risks. And while most had discussed alcohol and cigarettes use with their sons and daughters, they had not discussed PEDs.

So what are performance-enhancing supplements or drugs? And why would teens want to use them? Here’s a brief overview of some of the more common types to which young athletes may be exposed.

Creatine
Creatine is an over-the-counter nutritional supplement that has been marketed as a safe, ergogenic (performance-enhancing) aid. It’s commonly used in sports that require bursts of energy for a short period of time. Side effects include muscle cramps, dehydration and diarrhea. There is little information about creatine’s effect on children and teens. It is not regulated or tested by the Food and Drug Administration (FDA). A study by well-known sports pediatrician Jordan Metzl, M.D. and others reported creatine use in every grade, 6 to 12. Another study reported that 25% of male high school athletes and 4% of females said they used creatine. Creatine is also known commercially by these names, among others: ATP Advantage, Cell-Tech, Extra Advantage Creatine Serum and Creatine Booster.

Steroids (also known as Anabolic Steroids)
Most anabolic steroids are synthetic versions of testosterone, which is the male sex hormone responsible for the growth of skeletal muscle and sex characteristics. ‘Anabolic’ means building or growing. Available legally only by prescription, doctors often prescribe it to treat muscle wasting, delayed puberty and some breast cancers.

National surveys show that boys and girls in endurance and strength-oriented sports are susceptible to the steroid hook: increased muscle mass and the ability to train faster and for longer, with reduced time needed for recovery. Side effects include a halt in bone growth and damage to the heart, liver and kidneys. Steroids can lead to depression, mood swings, aggressive behavior, and fluid retention, among other effects. Parent and coaches might hear steroids referred to as ‘roids, andro, hype, pump or juice. There are more than 100 anabolic steroids on the market under such names as Anadrol, Winstrol, Oxadrin and Anavar.

Ephedra (also known as Ma Huang)
Ephedra is a stimulant that is similar to amphetamines. Student athletes may use it to drop weight, improve mental alertness and reduce fatigue. Side effects include insomnia, increased heart rate, high blood pressure, heart attacks, seizures and death.

While the FDA banned the sale of ephedra in 2004, some sports drinks and energy foods still contain this supplement or an ephedra “copy cat” that produces the same result. It can also be found in medications meant for other purposes, such as pseudoephedrine (i.e. Sudafed), a decongestant used for colds and allergies. Sold over-the-counter, these medications are increasingly used by athletes for their stimulant-like properties to enhance performance.

Energy Drinks
Energy drinks are increasing in popularity among athletes of all ages. While there are many to choose from, familiar brand names include Red Bull, Jolt or Blue Ox. They are purported to improve stamina, alertness and reaction time. Most are loaded with caffeine, sugar and other substances, such as ginseng, an herb thought by some to improve physical performance. Many of these drinks are enhanced by ephedra-free alternatives. Current marketing trends include mixing energy drinks with alcohol at parties, bars and other events typically attended by students. Side effects include dehydration, nosebleeds, nausea, abnormal heart rhythms and death. There is growing concern in the medical field about these products and their impact on children and teens.

What’s A Parent To Do?
Parents have an important role to play in helping to reduce student athlete use of performance-enhancing products and foster ethical play.

• First, educate yourself: learn more about the health risks of products your child can easily access. Good starting points include: www.healthycompetition.org, sponsored by the Blue Cross Blue Shield Foundation, the National Center for Drug Free Sports at www.drugfreesport.com, and www2.ncaa.org, to learn more.
• Next, talk to you child about performance-enhancing substances. State your expectations and discuss the health risks associated with common products.
• Get a handle on what they are buying at the store or over the Internet.
• Last, determine if your child’s coach, athletic trainer or school has rules in place to reduce the use of such products and learn what the school is doing to help educate your son or daughter about PED use.

Minnesota Sports Medicine (MSM) is a network of sports and orthopedic physicians who treat athletes at medical clinics throughout the Twin Cities metro area. To locate a sports medicine physician or for more information about MSM, call 612-273-4800 or visit www.mnsportsmed.org.